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APPLICATIGA FOR CONSTRUC"i PERMIT <br />CITY OF EVERETT R BUILDING DIVISION <br />3200 CEDAR STREET R EVERETT, WA 98201 R259-8810 <br />1 DEMOLITION 71 COMBINATION I I BUILDING 1-1 MECHANICAL PLUMBING FI SIGN <br />PROJECT ADDRESS 3 O S e <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />C- `rclCL1 CcwoCPNrSOtiI �$OS Cud<c� �Yleti4Fzo( <br />TENANT MAIL ADDnESS CITY ZIP PHONE <br />ARCHITECT On DESIGNen <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSER <br />)[cCi-'3c�� <br />�ktlt-VSIIPwfh-�rU <br />(D-h63"e- <br />MECHANICALCONTRACTOR <br />MAIL ADDRESS <br />C17Y <br />ZIP <br />PIIONE STATE LICINSER <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSER <br />N,II..---i'-;,<� <br />Lell!-T <br />DnC,37 f_'/P7, <br />iSS.20(-� <br />it.X/7JM-) <br />CONTRACT PnICE OF WORN <br />p T <br />HEATING SYSTEM: P GAS CI ELECTRIC F1 <br />DESCRIBE W RK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND[[296.200 WAC. <br />X T _Ii1�1.1, P {KOI / G/ ^ e, T <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAXI D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE N0. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />A/C—A/HNDLG UNITS — H.P. <br />BATH( UB <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />H <br />SHOWER <br />UNIT HEATERS —B.T.U. M <br />' <br />KITCHEN SINK 8 DISP <br />i <br />CLOTHES DRYERS <br />DISHWASHER <br />VENTILATION FAN <br />' <br />LAUNDRY TRAY <br />ANGEHOOD <br />i <br />CLOTHES WASHER <br />H <br />ATER HEATER <br />' <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />GAS RANGE <br />' <br />_ <br />GAS PIPING <br />i <br />EXHAUSTFAN <br />i <br />I <br />I <br />SUB TOTAL <br />$ <br />SUB TOTAL S <br />PERMIT <br />S <br />I <br />PERMIT S <br />i <br />TOTALFEE <br />$ <br />' <br />TOTAL <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAn SETBACK <br />SIDE SETBACK <br />PLAN CIIEC NUMBER <br />FEE <br />RECEIPT NO. <br />2 <br />USEZONE <br />LOT APEA <br />VACANT SITE <br />FEES I <br />VALUATION <br />FEE <br />BUILDING <br />H <br />' <br />tI YES IT NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDG/EI. <br />UNITS <br />PLUMBING <br />OCCUPANCY <br />NO OFSTORIES <br />OCCUPANILOAD <br />BASEMENT <br />MECHANICAL <br />7 ' <br />GROUP <br />I <br />OYES fT NO <br />ADDITIONAL PLAN CHECK <br />i <br />FIRE ALARM PEO'0 <br />REASON <br />OTHER <br />I <br />FIRE SPRINKLER REO'D <br />REASON <br />i <br />STATE BUILDING SURCHARGE <br />i <br />TYPE OF CONST. <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />i <br />LOCAL SALES <br />H <br />TAX CODE IS 3105 <br />TOTAL <br />(C3 I <br />DATE <br />